Indeterminate lesions on planar bone scintigraphy in lung cancer patients: SPECT, CT or SPECT-CT?

Abstract:

OBJECTIVE:The objective of the present study was to compare the role of single photon emission computed tomography (SPECT), computed tomography (CT) and SPECT-CT of selected volume in lung cancer patients with indeterminate lesions on planar bone scintigraphy (BS). METHODS:The data of 50 lung cancer patients (53 ± 10.3 years; range 30-75; male/female 38/12) with 65 indeterminate lesions on planar BS (January 2010 to November 2010) were retrospectively evaluated. All of them underwent SPECT-CT of a selected volume. SPECT, CT and SPECT-CT images were independently evaluated by two experienced readers (experience in musculoskeletal imaging, including CT: 5 and 7 years) in separate sessions. A scoring scale of 1 to 5 was used, in which 1 is definitely metastatic, 2 is probably metastatic, 3 is indeterminate, 4 is probably benign and 5 is definitely benign. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each modality, taking a score ≤2 as metastatic. With receiver operating characteristic (ROC) curve analysis, areas under the curve (AUC) were calculated for each modality and compared. Clinical and imaging follow-up and/or histopathology were taken as reference standard. RESULTS:For both readers SPECT was inferior to CT (P = 0.004, P = 0.022) and SPECT-CT (P = 0.003, P = 0.037). However, no significant difference was found between CT and SPECT-CT for reader 1 (P = 0.847) and reader 2 (P = 0.592). The findings were similar for lytic as well as sclerotic lesions. Moderate inter-observer agreement was seen for SPECT images (к = 0.426), while almost perfect agreement was seen for CT (к = 0.834) and SPECT-CT (к = 0.971). CONCLUSION:CT alone and SPECT-CT are better than SPECT for accurate characterisation of indeterminate lesions on planar BS in lung cancer patients. CT alone is not inferior to SPECT-CT for this purpose and might be preferred because of shorter acquisition time and wider availability.

journal_name

Skeletal Radiol

journal_title

Skeletal radiology

authors

Sharma P,Kumar R,Singh H,Bal C,Julka PK,Thulkar S,Malhotra A

doi

10.1007/s00256-011-1304-2

subject

Has Abstract

pub_date

2012-07-01 00:00:00

pages

843-50

issue

7

eissn

0364-2348

issn

1432-2161

journal_volume

41

pub_type

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